RISK ASSESSMENT WORKSHEET

Revision No. : 0 Risk Assessment No. : O&M-15

Department : Operation & Maintenace Risk Assessment Team : Muhadi, Fahrizal, Lischayono
Task Evaluated : Jacking Operation
Cost Centre No. : - Team Leader : Agustiono Date : 29/03/2021
(Name & Signature)
Approved By : Colin Lim Senior Operation Manager Date : 29/03/2021
(Name & Signature) (Designation)
Hazard Identification Risk Evaluate Risk Control Re-Risk Eval. Responsibility Reference
(Identifikasi Bahaya) (Resiko Dievaluasi) (Langkah-Langkah Pengedalian) (Resiko Dievalusi) (Tanggungjawab) (Referensi)

Task Step Hazard Existing Measure Additional Control Measure Designation Reference Document
No. S L RL S L RL
(Langkah Kerja) (Bahaya) (Pengedalian Yang Dilakukan) (Tindakan Pengedalian Tambahan) (Dilakukan Oleh) (Dokumen Referensi)

Remind worker routinely on safe hand position

Use proper PPE (I.e hand
Hand injury 2 D M during toolbox & do not use torn or defective 2 C M P3-S07 ( PPE )
gloves ) for manual handling.
safety gloves

Provide safe ingress / egress and

Carry out daily housekeeping to keep all
Slip, trips and fall adequate lighting in low visibility 2 D M 2 C M
storage area tidy and as much as possible
area

No Hot work is allowed without a proper & valid

No Smoking is allowed in the 4 C H hot work permit 4 B M Tool Keeper and
1 Storage Jacking unit
storage area Keep area free from spill of flammable liquid Supervisor

Fire and Explosive

Certified fire extinguisher to be
available at storage area
Ensure that tool keeper staff has been informed
to use the fire extinguisher in the event of a fire
4 C H 4 B M
Segregata combustible and flammable material
from heat sources

Do Not overload the storage rack or place loose

Struck by falling object / items at the rack edges.
Secure all loose material 2 D M 2 C M
Material Placed jacking unit at lower lever for prevent
back injury

Use proper PPE (safety helmet, Remind worker routinely on safe handling
Personnel Injury safety glass, safety shoes ) for 2 D M position during toolbox & do not use torn or 2 C M
manual handling. defective PPE.

Manual Handling, Carry Failure to properly check

2 jacking unit from storage Use daily operations checklist to Supervisor must ensure daily checklist carry out
on Jacking unit before 1 C L 1 B L
to worksite identify & ensure safe use of before take from storage
carry to worksite
jacking unit

Supervisor and store keeper must provide box

Property damage due to Use box container to carry
4 C H before worker carry jacking unit from storage to 4 B M
improper carry jacking unit
worksite

Page 1 of 5 Note: S (Severity / Keparahan), L (Likelihood / Kemungkinan), RL (Risk Level / Tingkat Resiko) P3-S01-F3
 RISK ASSESSMENT WORKSHEET
Revision No. : 0 Risk Assessment No. : O&M-15
Department : Operation & Maintenace Risk Assessment Team : Muhadi, Fahrizal, Lischayono
Task Evaluated : Jacking Operation
Cost Centre No. : - Team Leader : Agustiono Date : 29/03/2021
(Name & Signature)
Approved By : Colin Lim Senior Operation Manager Date : 29/03/2021
(Name & Signature) (Designation)
Hazard Identification Risk Evaluate Risk Control Re-Risk Eval. Responsibility Reference
(Identifikasi Bahaya) (Resiko Dievaluasi) (Langkah-Langkah Pengedalian) (Resiko Dievalusi) (Tanggungjawab) (Referensi)

Task Step Hazard Existing Measure Additional Control Measure Designation Reference Document
No. S L RL S L RL
(Langkah Kerja) (Bahaya) (Pengedalian Yang Dilakukan) (Tindakan Pengedalian Tambahan) (Dilakukan Oleh) (Dokumen Referensi)

Injury to personnel or P3-SO7-PPE

Plan and prepare property damage due to Ensure the jack up procedure is
Prior to jack up, QA/QC personnel to coordinate Approved Procedure
procedure for Jack Up of lack of checks or jointly checked & relevant PTW is
& approve on weld joint conditions with relevant (refer to attached)
the skid. planning. duly filled and approved.
parties. Project Manager,
3 3 C M 3 B M QA/QC, Lifting
Merencanakan dan Luka ada pekerja atau Pastikan prosedur mendongkrak
Sebelum mendongkrak, personil QA/QC harus Supervisor & HSE
menyiapkan prosedur kerusakan harta benda diperiksa bersama & surat ijin
mengkoordinasi & menyetujui kondisi
untuk mendongkrak karena kurang kerja (PTW) yang relevan diisi
pengelasan dengan pihak relevan.
skid. pengecekan atau dengan benar & disetujui.
perencanaan.
2. Preparation / Assembling Pinch Point ( Hand&  Use proper PPE while 2 D M  Worker to be routinely reminded on hand 2 C M Supervisor & Worker
of Hydroulic jack Fingers injury ) working. injury prevention.
equipment  Gunakan APD dengan benar  Pekerja agar diingatkan secara rutin
Potensi terjepit ( Cidera ketika bekerja. mengenai pencegahan cidera tangan.
Persiapan dan memasang tangan dan jari ).
alat dongkrak hydrolic.  Ensure only fit testing  Only one dedicated leader to supervise the
hydroulic jack and updated jacking operational.
inspection to be use.  Hanya satu pemimpin kerja untuk mengatur
selama pekerjaan mendongkrak.
 Pastikan hanya jack yang fit
dan inspeksi update yang  Ensure the hose and fittings are free from
diperbolehkan untuk defect & pre-operational check are
digunakan. performed.
 Pastikan selang dan fitting yang digunakan
 Ensure the hydroulic valve is tidak terdapat kerusakan & dilakukan
correctly set in relation to the pengecekan sebelum dioperasikan.
jacking pressure.
 Pastikan katup di pasang  Pre-Job briefing shall be done.
dengan benar dengan  Pre-Job briefing agar dilakukan.
tekanan dongkrak.
 Permit To Work shall be issued
 Modificated hydroulic hose  Surat Izin Kerja agar dibuat
connection is prohibited.
 Pastikan sambungan selang  Use proper tools and equipment.
hydroulic modifikasi tidak  Gunakan peralatan yang sesuai
diizinkan untuk digunakan.
 Fire Extinguisher to be available.
 Ensure correct rating in  Siapkan Alat Pemadam Api Ringan
accordance to approved
load / procedure.  Spill kit to be available for emergency spill (
 Pastikan rate beban sesuai leaking hydroulic hose ).
dengan prosedur yang  Spill kit tersedia untuk keadaan darurat
disetujui. ( Kebocoran selang hydroulic )

Page 2 of 5 Note: S (Severity / Keparahan), L (Likelihood / Kemungkinan), RL (Risk Level / Tingkat Resiko) P3-S01-F3
 RISK ASSESSMENT WORKSHEET
Revision No. : 0 Risk Assessment No. : O&M-15
Department : Operation & Maintenace Risk Assessment Team : Muhadi, Fahrizal, Lischayono
Task Evaluated : Jacking Operation
Cost Centre No. : - Team Leader : Agustiono Date : 29/03/2021
(Name & Signature)
Approved By : Colin Lim Senior Operation Manager Date : 29/03/2021
(Name & Signature) (Designation)
Hazard Identification Risk Evaluate Risk Control Re-Risk Eval. Responsibility Reference
(Identifikasi Bahaya) (Resiko Dievaluasi) (Langkah-Langkah Pengedalian) (Resiko Dievalusi) (Tanggungjawab) (Referensi)

Task Step Hazard Existing Measure Additional Control Measure Designation Reference Document
No. S L RL S L RL
(Langkah Kerja) (Bahaya) (Pengedalian Yang Dilakukan) (Tindakan Pengedalian Tambahan) (Dilakukan Oleh) (Dokumen Referensi)

 Discuse and coordinate the

work in TBT / PSCC meeting
to ensure all are made
aware.
 Diskusi kegiatan pada TBT /
PSCC meeting untuk
memastikan semua peduli
dengan kegiatan ini.

 Proper working platform to

be provided when required
 Panggung kerja yang
memadai harap disediakan.
Slip, Trip, Fall
 Housekeeping and hose/ 2 C M Supervisor & Worker
Tergelincir, Tersandung,
cable management to
Jatuh
maintain.
 Housekeeping dan
pengaturan selang dan kabel
agar dijaga.
3. Jaking activity Struck by flying objects.  Cordoned off or post the sign 3 C M  Only skill and trained personnals is 3 B M PMT / Engineering Approved Procedure
board for the jacking activity allowed to perform the jacking operation. Supervisor & Worker (refer to attached)
Aktivitas mendongkrak Terkena benda yang to allert the personnal  Hanya yang ahli dan terlatih yang
terbang around the area. diizinkan untuk melakukan kegiatan
 Barikade lokasi kegiatan atau mendongkrak.
pasang tanda untuk
memperingatkan pekerja  Safe metode as per jacking procedure
disekitarnya. and calculation engineering.
 Metode yang aman sesuai dengan
 Jacking activity shall be done prosedure mendongkrak dan perhitungan
as refer to PMT / Engineering engineering.
costruction.
 Kegiatan mendongkrak agar  Monitoring by relevant lead.
dilakukan sesuai instruksi  Monitor oleh petugas yang bersangkutan.
PMT / Engineering.

 Ensure no over load

hydroulic pressure.
 Pastikan tidak terjadi
kelebihan beban.

Page 3 of 5 Note: S (Severity / Keparahan), L (Likelihood / Kemungkinan), RL (Risk Level / Tingkat Resiko) P3-S01-F3
 RISK ASSESSMENT WORKSHEET
Revision No. : 0 Risk Assessment No. : O&M-15
Department : Operation & Maintenace Risk Assessment Team : Muhadi, Fahrizal, Lischayono
Task Evaluated : Jacking Operation
Cost Centre No. : - Team Leader : Agustiono Date : 29/03/2021
(Name & Signature)
Approved By : Colin Lim Senior Operation Manager Date : 29/03/2021
(Name & Signature) (Designation)
Hazard Identification Risk Evaluate Risk Control Re-Risk Eval. Responsibility Reference
(Identifikasi Bahaya) (Resiko Dievaluasi) (Langkah-Langkah Pengedalian) (Resiko Dievalusi) (Tanggungjawab) (Referensi)

Task Step Hazard Existing Measure Additional Control Measure Designation Reference Document
No. S L RL S L RL
(Langkah Kerja) (Bahaya) (Pengedalian Yang Dilakukan) (Tindakan Pengedalian Tambahan) (Dilakukan Oleh) (Dokumen Referensi)

 Release / encrease the

jacking pressure with safe
metode.
 Ensure the hose and fittings are free from
 Menurunkan / menambah
defect & pre-operational check are
Failure equipment / may tekanan dengan metode
performed.
couse injury yang aman.
 Pastikan selang dan fitting yang digunakan
3 C M tidak terdapat kerusakan & dilakukan 3 B M Supervisor & Worker
Kegagalan peralatan  Proper PPE to be use
pengecekan sebelum dioperasikan.
yang menyebabkan  Menggunakan APD yang
cidera tepat.
 Cordon off at jacking area.
 Pasang pembatas dilokasi kegiatan
 Proper communication to be
maintain.
 Jaga komunikasi dengan baik

 Hydroulic pump to be protect

 Pompa hydroulic agar
 Fire extinguisher to be available.
dilindungi
 Alat pemadam api disediakan
Fire and electrical hazard
 Ensure the hydroulic pump is
2 D M  Ensure all electrical equipment’s is properly 2 C M Supervisor & Worker
Bahaya kebakaran dan safe away from effected
working.
kelistrikan areas.
 Pastikan peralatan listrik dalam kondisi
 Pastikan pompa hydroulic
baik.
ditempatkan di tempat yang
aman.

 Competent and experianced

personnal is only allowed to
operate the jack( Hand jack,
Pump jack, electrict jack )
 Hanya orang yang
Struck by imbalance load. berkompeten dan
Closed supervise by supervisor
berpengalaman untuk
3 D H 2 C M Supervisor & Worker
Terkena beban yang mengoperasikan dongkrak.
Pengawasan agar dilakukan oleh Supervisor
tidak seimbang
 Signal man to be assgned ( if
neccessery )
 Pemberi sinyal agar
disediakan ( jika
dibutuhkan )

Page 4 of 5 Note: S (Severity / Keparahan), L (Likelihood / Kemungkinan), RL (Risk Level / Tingkat Resiko) P3-S01-F3
 RISK ASSESSMENT WORKSHEET
Revision No. : 0 Risk Assessment No. : O&M-15
Department : Operation & Maintenace Risk Assessment Team : Muhadi, Fahrizal, Lischayono
Task Evaluated : Jacking Operation
Cost Centre No. : - Team Leader : Agustiono Date : 29/03/2021
(Name & Signature)
Approved By : Colin Lim Senior Operation Manager Date : 29/03/2021
(Name & Signature) (Designation)
Hazard Identification Risk Evaluate Risk Control Re-Risk Eval. Responsibility Reference
(Identifikasi Bahaya) (Resiko Dievaluasi) (Langkah-Langkah Pengedalian) (Resiko Dievalusi) (Tanggungjawab) (Referensi)

Task Step Hazard Existing Measure Additional Control Measure Designation Reference Document
No. S L RL S L RL
(Langkah Kerja) (Bahaya) (Pengedalian Yang Dilakukan) (Tindakan Pengedalian Tambahan) (Dilakukan Oleh) (Dokumen Referensi)

 Wear proper PPE and stay

away from release point.
Eye injury due to small
 Gunakan APD yang tepat dan
particles upon release by
Dis-assembling menjauh dari lokasi titik Supervisor and HSE personnal to be monitor the
pressure.
realese. activity. Supervisor, HSE & Approved Procedure
4. 3 D H 3 C M
Melepaskan peralatan /  Worker (refer to attached)
Cidera pada mata jika
pekerjaan selesai  Cordon off the location & Supervisor dan HSE harus memonitor kegiatan
ada partikel terlepas dan
display warning sign.
mengenai mata
 Pasang pembatas area dan
pasang tanda peringatan

Page 5 of 5 Note: S (Severity / Keparahan), L (Likelihood / Kemungkinan), RL (Risk Level / Tingkat Resiko) P3-S01-F3